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CMW Sneak Peek: Complex Case: Two strategies for dealing with the uninsured

Case Management Weekly, July 9, 2008

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One of the advantages of having an ED case management program is having a case manager available for referrals when needed, but also having the case managers find cases on their own. In these situations, the case manager often is able to find resourceful strategies that otherwise may have been overlooked. Two examples from one hospital’s case management program show outcomes from two cases involving uninsured patients. In one case, the patient was referred to the case manager and in the other, the case manager found the case on her own. By interviewing and assessing each patient, the case managers were able to get both patients the individualized help they needed.

Sylvia is a 39-year-old female with uncontrolled diabetes and glaucoma. Sylvia is intelligent and has a stable job, but she has stopped taking her medications. She doesn’t have insurance and had been enrolled in the city clinic, but because of her work and family commitments, had missed some appointments. The clinic then dismissed her from the program. In addition, the clinic has since lost its funding and will be unable to take her back, no matter what.

The next case involves a 21-year-old girl with a swollen jaw named Debbie. Debbie is diagnosed with an infection and is given antibiotics and a referral for further outpatient treatment. The ED physician discovers that Debbie has no insurance and therefore immediately offers courtesy medications available through the hospital program. Often, when hospitals have this program, they automatically enroll uninsured patients without checking for alternatives first.

Check out the June 2008 issue of Case Management Monthly to get the full story, and discover all the benefits of being a Case Management Monthly subscriber.

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